HCPCS G2211 code and billing history
Material coding, documentation, and Medicare billing changes, shown by effective date and backed by the source that established each change.
Changes to G2211 Copy link
Changes to this code’s definition, documentation, selection, or payment status.
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Effective Jan 1, 2025
G2211 gained a limited modifier 25 exception
Medicare began allowing G2211 with a qualifying office/outpatient E/M base code, 99202-99205 or 99211-99215, with modifier 25 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.
- Before
- G2211 was denied whenever the associated office/outpatient E/M base visit carried modifier 25.
- After
- A limited exception permits G2211 when an annual wellness visit, vaccine administration, or another CMS-listed eligible Part B preventive service is also furnished on the same date in the office or outpatient setting.
Also affects 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
View evidence (2 sources)
- Primary: CMS Change Request 13705: G2211 with listed preventive services — Pages 1-3 and Attachment 1.
- Corroborating: CMS CY2025 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
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Effective Jan 1, 2024
G2211 became separately payable
Medicare began paying G2211 in addition to qualifying office/outpatient E/M base visits, codes 99202-99205 and 99211-99215. At launch, G2211 was not payable when the base visit carried modifier 25.
- Before
- G2211 was reportable for qualifying visits but bundled, with no separate Medicare payment.
- After
- G2211 was separately payable for qualifying visits unless the associated base visit was reported with modifier 25.
Also affects 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
View evidence (2 sources)
- Primary: CMS MLN Matters MM13272: G2211 payment and modifier 25 edits — Pages 1-2, Action Needed and Background.
- Corroborating: CMS CY2024 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
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Effective Jan 1, 2021
G2211 became reportable, but remained bundled
For qualifying longitudinal-care visits, G2211 could be reported with any new- or established-patient office/outpatient visit level, 99202-99205 or 99211-99215. Medicare assigned it bundled status, so it did not produce separate payment.
- Before
- No G2211 reporting relationship applied to these visits.
- After
- G2211 was reportable for qualifying longitudinal-care visits but bundled under the Medicare Physician Fee Schedule.
Also affects 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
View evidence (2 sources)
- Primary: CMS CY2021 office/outpatient E/M payment fact sheet — Page 2, Add-on Code for Visit Complexity.
- Corroborating: CMS CY2024 Physician Fee Schedule final rule fact sheet — Evaluation and Management Visits section.
Looking for payment amounts instead? See the Medicare rate history for G2211.